Helga Noice
Tony Noice
Illinois, United States

 

Last month, anyone walking by the auditorium of Lewis University Oak Brook campus for the Hektoen Institute presentation would probably have been startled by the gales of laughter coming through the doors of this usually serious academic meeting. However, the reaction was simply the result of a demonstration of a new theatrically-based intervention to enhance healthy cognitive aging through acting exercises.Because of the maturing of the baby boomer generation, recent research has focused on devising approaches to promote healthy cognitive aging or to ameliorate cognitive decline. Two strands of inquiry have been particularly prominent. The first consists of studies in which the participants are trained on a specific cognitive skill such as verbal episodic memory, reasoning, or speed of processing (e.g., Willis et al., 2006). The second strand of research (using both prospective and retrospective paradigms) involves identifying activities that are associated with healthy cognitive aging (for a review, see Small et al., 2006).Many of the earlier training studies focused on mnemonic techniques such as the method of loci in which items to be remembered are associated with various locations in one’s own home. Using this technique, Robertson-Tchabo et al. (1976) demonstrated remarkable gains of 79% in list-learning ability after five days of intensive instruction. However, such targeted approaches did not appear to generalize to other memory tasks. In a meta-analysis, Verhaeghen et al (1992) examined an array of studies showing improvements in experimental groups after memory instruction compared to both control and placebo groups, but concluded that “the plasticity associated with mnemonic training appears to be largely specific to that training” (p. 249).

In a large-scale study known as ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), Ball et al. (2002) randomly assigned participants to one of three intervention groups or a no-contact control group. Those in the intervention groups were given instruction designed to enhance one of the following cognitive abilities: verbal memory, reasoning ability, or speed of processing. Participants were assessed six weeks later, and improvements were found in all three areas. Two years later, the researchers reported that, although these improvements had persisted, this cognitive intervention “helped normal elderly individuals to perform better on multiple measures of the specific cognitive ability for which they were trained. It did not, however, demonstrate the generalization of such interventions to everyday performance – at least in the first two years” (p. 2278). Furthermore, training in one cognitive ability (e.g., verbal memory) did not increase performance on a different ability (e.g., speed of processing). A follow-up examination of these same participants five years later found that the improvements in the trained abilities were still present, especially in those participants who had been given booster training one and three years after the original intervention (Willis et al., 2006).

 

At least one prominent aging researcher has offered evidence that, despite the positive changes documented in the large number of interventions, the actual overall rate of cognitive decline in older adults does not appear to be reduced (Salthouse, 2006). On the other hand, Salthouse has also pointed out that interventions may have salutary effects because a temporary boost in cognitive functioning sets a new, higher point from which the slope of decline resumes. Therefore, if there is a point in time at which an older adult can no longer function on his or her own, delaying that point is certainly worthwhile. Willis eloquently captured this type of advantage in her statement about the original and the long-term follow-up study of the ACTIVE participants: “The improvements in memory, problem-solving, and concentration after training roughly counteracted the degree of cognitive decline that older people without dementia may experience over a 7 to 14 year period.”

The other promising approach to the problem of cognitive decline concerns the relationship between stimulating activities and healthy cognitive aging. For example, Wilson et al. (2002) recruited 801 Catholic nuns, priests, and brothers who were over 65 years of age. Before starting, each participant filled out a questionnaire about the frequency of intellectually stimulating leisure pursuits in which they generally engaged (e.g., reading, doing crossword puzzles). Frequency was rated on a 5-point scale with 5 being highest. After five years, it was found that for each additional point on the stimulating activity scale, there was a 33% decrease in the risk of developing Alzheimer’s disease. Indeed, a very wide variety of studies have shown a positive relationship between mentally stimulating activities and intellectual functioning (e.g., Schooler & Malatu, 2001), between social activity and survival (e.g., Lennartsson & Silverstein, 2001), and between high levels of mental activity and lower risk of dementia (e.g., Friedland et al., 2001).

Some studies have pointed to two specific elements of engagement that might be responsible for cognitive gains: novelty and multi-modal stimulation. Hultsch et al. (1999) presented evidence that novel endeavors, such as learning a foreign language, might be responsible for improved performance on such tasks as fact recall, word recall, and story comprehension. Glass et al. (2004) suggested that multi-modal (i.e., cognitive and affective) stimulation was responsible for the enhanced cognition reported by seniors when they gave math and literacy tutoring to inner-city school children. These studies would seem particularly relevant to the intervention described here, which involves activities that are highly novel and necessarily multi-modal.

For over twenty years, one major strand of our research has involved specifying the mental processes of professional actors (for reviews, see Noice & Noice, 1997, 2002, 2004, 2006a) and applying the results to cognitive improvement in the general population (e.g., Noice & Noice, 1997; 2006b; 2009; Noice, Noice & Staines, 2004). The early phase of these investigations involved identifying the cognitive principles that lay behind actors’ highly efficient learning strategies. This line of inquiry uncovered a two-stage process of role acquisition. The first is analytical and takes place during initial script study. The second stage takes place during rehearsal and performance. Thus, if the preliminary analysis showed that the character was, for example, demanding obedience from another character, the actor would then use the words of the playwright to actively experience the process of demanding obedience. This involvement would necessarily be cognitive (the thoughts that the dramatic situation of “demanding obedience” activates), affective (feelings of superiority and domination), and physiological (a tightened jaw and aggressive body movement). The particulars would differ from actor to actor and from situation to situation, but the unvarying essence would be that the actor is experiencing the mental-emotional-physical concomitants of the communication and not just trying to look and sound like someone demanding obedience. The latter is called “indicating” and is considered a hallmark of bad acting. The concept of genuinely experiencing the on-stage transaction at every performance turned out to have wide application in designing a theatre intervention to promote healthy aging. The researchers refer to this concept as the active experiencing principle (AE).

 

Training of novices in actors’ learning strategies

To test the efficacy of AE with non-actors, college students – primarily psychology undergraduates who had no theatrical training or experience – were required to actively use pre-written dialogue the way one does in daily living. They were specifically instructed not to try to memorize the material, but just to use the words as they would in real life. Students in the control (memorization) group were told to memorize the same material using whatever strategy they had found useful in the past. Participants using the active experiencing strategy remembered significantly more of the text than those using the memorization strategy (M = .641 vs. M = .445). The significance level was <.001, meaning that that result could have been obtained by chance only one time in a thousand. These results showed that students, when told not to memorize the words, but to use them as tools to attain the goals of the character within the scripted situation, learned significantly more material than those who set out to deliberately memorize those same words. Thus the process of trying to “live” the material rather than just learning it appeared to make a major difference in the results.

 

Testing the strategy with older adults

Having shown that actors’ strategies can improve college students’ memory performance, the investigators turned to applying these principles to older adults in their sixties through nineties. The investigators hypothesized that if tangible skills could be distilled from the active experiencing strategies called upon by actors learning their lines, training older adults using these highly demanding mental tactics would enhance this demographics’ overall cognitive functioning. In an experiment that served as a prototype for future interventions (Noice et al., 1999), participants ranging in ages 65 to 82 were recruited from the Basler IDA Project in Switzerland, an ongoing longitudinal memory study (Perrig-Chiello et al., 1996). They were pre-tested with immediate and delayed recall and recognition tasks. Then, they went through a four-week course in acting with the emphasis on understanding the deeper meaning of the dialogue given to them. Using that understanding, they were asked to engage in truthful interactions with their fellow actors. The investigators found significant pre-post increases in the participants’ ability to remember lists of unrelated words or to recognize words that were on the original list when they were randomly mixed in with similar words.

This enhanced performance occurred despite the fact that nothing in the actors’ strategy (which involved identifying with the character’s motivations when using a coherent script) was of any strategic benefit to the recall and recognition tasks. No claim was being made that four weeks of training could turn these participants into professional-level actors; however, the very attempt of applying the active experiencing methodology – even over this short one-month period – appeared to enhance cognitive functioning. Based on these results, the investigators concluded that the active experiencing skills used by actors translated into an effective tool to increase the cognitive efficiency of older adults. The investigative team decided to replicate this experiment in the United States, targeting senior centers. Therefore, the Noices applied for funding from the U.S. National Institute of Aging and were awarded two grants over a period of five years to replicate and extend the Swiss study in a more tightly controlled environment with just under two hundred and fifty participants.

 

The NIA Supported Studies

Three groups were recruited for each study: an experimental group (theatre), a no-treatment control group, and a group to control for non-content-specific effects (visual art in the first study and music in the second). All participants were pre-tested on both cognitive and affective measures. The experimental and the alternative intervention groups received four weeks of training (two sessions per week). All three groups took the post-tests the day after the final session. The results of the first NIA study showed participants with an average age of 73.2 achieving significant increases in both cognitive and affective functioning.

To further test the hypothesis, the second study was performed with participants who were almost a full decade older and far less educated, many of them living in subsidized retirement homes. The overall design of both studies was very similar.

The second study used an expanded battery of tests.¹ The cognitive measures employed were:

• • • • • Word List Memory
        • Word List Delayed Recall
        • Category Fluency
        • Digit Span Forward
        • Digit Span Backward
        • East Boston Story Recall Task (immediate and delayed)
        • Means-end Problem Solving

The data revealed that the intervention produced strong gains in this older, less well-educated population, confirming the original hypothesis (Noice & Noice, 2009). The theatre group significantly outperformed the no-treatment control group on almost all cognitive measures, as assessed by a multivariate analysis of covariance, with group membership as the independent variable (theatre, music, no-treatment); age, education and pre-test scores as the covariates; and the eight cognitive variables as the dependent variables. Immediate recall of the East Boston test, which assesses comprehension and memory for a prose passage, had a significance level of p = .06. Only the forward and backward digit spans were at a significance level of >.10 and were therefore considered non-significant. When the results of the theatre group’s cognitive tests were compared with the alternate (music) group’s tests on the same measures, the theatre group also outperformed them on almost all variables.

An important aspect of these studies was that the tests did not evaluate the acting training, but simply assessed memory and problem solving abilities necessary or helpful for maintaining self-sufficiency in older adults. This procedure is relatively rare. In many cognitive interventions, the instruction is specifically targeted, such as training participants to solve serial pattern problems (e.g. Fill in the blank for this series: 1, 2, 4, 8, __) and then testing them on the same sorts of problems. Some interventions have included practice runs on the test procedures themselves. However, nothing in the theatre intervention experiment involved practice on tasks similar to those on the test, nor were the participants taught any test-taking strategies. Therefore, the improvements would appear to have been the result of the intense activation experienced by imaginatively becoming immersed in fictional situations and performing them. As to the theoretical question of an underlying cognitive mechanism, we believe the positive results are driven by the aforementioned concept of active experiencing.

In effect, AE is an amplification of the construct of mindfulness (e.g., Langer, 1989, Sternberg, 2002), which has been shown to enhance learning and other cognitive functions. However, AE goes far beyond the original formulation of mindfulness. That is, instead of merely being actively engaged in the present moment, participants are coached to become totally absorbed in attempts to obtain their characters’ goals. This requires cognitive, physiological, and emotional involvement —such as monitoring other participants’ facial expressions, tones of voice, and body language. The instruction itself consists of increasingly demanding exercises designed to have participants experience the essence of acting (i.e., to become engrossed in communicating the meaning of the dialogue so that obvious situation-specific cognitive/affective/physiological alterations occur in their demeanor). Other aspects of acting, such as role memorization, are not addressed, meaning that the entire intervention can be devoted to practicing the core process. All exercises and scenes used in the course are very short, easily retained, and performed with the written scripts in the participants’ hands so that they can glance down at them when needed. We feel that this is indeed an intriguing finding: the theatre intervention employing the active experiencing principle does not demand any actual memorization, but consistently improves memory performance.

There is, however, more work to be done. Until now, the interventions have all been conducted by the same professional actor-director-professor who devised the technique. We are currently investigating the issue of generalizability. That is, is the success of the intervention due to the specific qualities, talents, and personality of the original instructor; or can a wide variety of individuals teach it successfully after proper training? A recent pilot study has produced evidence that another experienced acting teacher could easily learn the procedures and produce similar results. Therefore, we are hopeful that in implementing this technique in practice, we can recruit experienced acting teachers throughout the country to carry out this effective intervention.

This program uniquely brings together factors that support healthy cognitive aging. The intervention is novel, mentally and emotionally stimulating, takes place in a supportive social atmosphere, and is so enjoyable that it encourages continued participation. Indeed, it gives new meaning to the theatre cliché, “The show must go on.”

 

Notes

1. The tests we used assessed short-term memory (word list), long-term memory (word list delayed and East Boston Story Recall delayed), semantic memory (category fluency), short-term memory capacity (digit span forward and backward), comprehension (East Boston Story Recall) and problem solving (Means-End Problem Solving).

 

References

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HELGA NOICE, PhD, is a professor of psychology at Elmhurst College; she earned her PhD in Cognition at Rutgers University.

TONY NOICE, PhD, is a professor of theatre at Elmhurst College, and earned his PhD at Wayne State University.

The Noices’ work has been funded by the National Science Foundation (NSF), Pew Charitable Trust, Schweizerischer Nationalfond, Elizabeth Morse Charitable Trust, and the National Institutes of Health (NIH). The NIH has supported the Noices’ research since 1999, with 3 consecutive grants. In addition to the many peer-reviewed articles in professional journals, this intervention has been featured on over 25 national and international media outlets, including the NBC Nightly News With Brian Williams, PBS-TV, ABC-TV, the Chicago Tribune, the Los Angeles Times, and the Times of London.

 

Highlighted in Frontispiece Spring 2010 – Volume 2, Issue 2
Spring 2010  |  Sections  |  Psychiatry & Psychology